REG-1, Business Taxes Registration Application

1 Department of Revenue ServicesState of ConnecticutPO Box 2937 Hartford CT 06104-2937(Rev. 12/12)Form REG-1 Business Taxes Registration Application1. Reason for Filing Form REG-1 Check the applicable box: Opening a new Business including but not limited to:a. An existing out-of-state Business opening a location in connecticut ;b. Selling at a craft show, flea market, fair, or other venue in connecticut or selling over the Internet; or c. An existing out-of-state Business having employees in connecticut (including nonresident contractors and loan-out companies).

2 Opening a new location. Enter your connecticut Tax Registration No: _____ Registering for additional Taxes . Enter your connecticut Tax Registration No: _____ Reopening a closed Business . Enter connecticut Tax Registration No. of the closed Business : _____ Purchasing an ongoing Business . The buyer of an existing Business may be responsible for tax liabilities of the previous owner. See the Informational Publication on Successor Liability for Sales and Use Taxes , Admissions and Dues Tax, and connecticut Income Tax Withholding, on the DRS connecticut Tax Registration No.

3 Of the previous owner: _____ Forming a Business entity under connecticut law or a non- connecticut entity required to register with or to obtain acertificate of authority from the connecticut Secretary of the State before transacting Business in connecticut . Establishing a passive investment company (PIC). Changing organization type. Enter your current connecticut Tax Registration No: _____ Hiring household employees and intend to withhold connecticut income tax. Other (explain); see Who Needs to Complete REG-1. _____2. Business Information.

4 Type of organization Sole proprietorship Single member LLC (SMLLC) Corporation Single member LLC taxed as a corporation S Corporation General partnership Single member LLC taxed as an S corporation Qualified subchapter S subsidiary (QSSS) Limited liability partnership (LLP) Limited liability company (LLC) taxed as a partnership Limited liability company (LLC) taxed as a corporation Limited partnership (LP) Limited liability company (LLC) taxed as an S corporation Limited partnership taxed as a corporation Other (explain): _____3.

5 Nature of Business ActivityCheck the box(es) that best describe your Business : Retailer Wholesaler Manufacturer Service provider Other (explain): _____4. Major Business ActivityDescribe your major Business activities: _____ _____5. Business Name and AddressOrganization name: Enter the name of the sole proprietor, partnership, corporation, or LLC. Federal Employer Identification Number, if applicableBusiness trade name CT Secretary of the State Business ID No., if applicableBusiness Location: Enter the physical address of the Business .

6 A post office box or rural route number is not acceptable. Home-based businesses and flea market or craft show vendors must enter a home line 1 Address line 2 City State ZIP codeMailing address line 1 (Street or PO Box) Address line 2 City State ZIP codeBusiness telephone number Email address Bank name( ) DRS use only connecticut Tax Registration NumberPage 1 of 4 Page 2 of 47. Income Tax WithholdingAre you an employer that transacts Business or maintains an office in connecticut and intends to pay wages to resident employees or nonresident employees who work in connecticut ?

7 Yes NoIf you have a connecticut tax Registration number for withholding for another location and intend to file withholding for this new location under that number, enter that number here: _____and skip to Section 8; otherwise you an out-of-state company voluntarily registering to withhold connecticut income tax for your connecticut resident employees who work outside of connecticut ? .. Yes NoDo you intend to withhold connecticut income tax from pension plans, annuity plans, retirement distributions, or gambling distributions?

8 Yes NoDo you pay nonresident athletes or entertainers for services they render in connecticut ? .. Yes NoDo you only have household employees and wish to withhold connecticut income tax? .. Yes NoDo you only have agricultural employees and wish to withhold connecticut income tax? .. Yes NoIf Yes, do you file federal Form 943, Employer s Annual Tax Return for Agricultural Employees, and wish to file Form CT-941, connecticut Quarterly Reconciliation of Withholding, annually? .. Yes No If you answered Yes to any of the income tax withholding questions, enter the date you will start withholding connecticut income tax.

9 If you use a payroll service, enter the name of the payroll company: _____ __ - __ __ - __ __ m m d d y y6. List All Owners, Partners, Corporate Officers, or LLC Members Attach a separate sheet if (last, first, middle initial) TitleHome address line 1 (street) Home address line 2 City State ZIP code Home telephone number ( )SSN Date of birth Bank name / / Name (last, first, middle initial) TitleHome address line 1 (street) Home address line 2 City State ZIP code Home telephone number ( )SSN Date of birth Bank name / / Name (last, first, middle initial)

10 TitleHome address line 1 (street) Home address line 2 City State ZIP code Home telephone number ( )SSN Date of birth Bank name / / Name (last, first, middle initial) TitleHome address line 1 (street) Home address line 2 City State ZIP code Home telephone number ( )SSN Date of birth Bank name / / Page 3 of 48. Sales and Use Taxes Do you sell, or will you be selling, goods in connecticut (either wholesale or retail)? .. Yes No Do you rent equipment or other tangible personal property to individuals or businesses in connecticut ?